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General NPI Number Information
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NPI Number | 1508770058
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Entity Type | Organization
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Legal Business Name | GLUCKSTADT DENTAL PLLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 1085 GLUCKSTADT RD BLDG 100
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City | GLUCKSTADT
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State | MS
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Zip | 39110-9425
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Country | US
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Telephone | 601-898-2228
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Fax |
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Provider Business Mailing Address
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Address Line | 1085 GLUCKSTADT RD BLDG 100
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City | GLUCKSTADT
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State | MS
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Zip | 39110-9425
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Country | US
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Telephone | 601-898-2228
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | BRADEN MCINTEER
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Credential | DMD
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Telephone | 601-898-2228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | NULL
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